Acupuncture for insomnia

Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are widely practised. However, it remains unclear whether current evidence is rigorous enough to support acupuncture for the treatment of insomnia. To determine the efficacy and safety of acupuncture for insomnia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), the World Health Organization (WHO) Trials Portal (ICTRP) and relevant specialised registers of the Cochrane Collaboration in October 2011. We screened reference lists of all eligible reports and contacted trial authors and experts in the field. Randomised controlled trials evaluating any form of acupuncture for insomnia. They compared acupuncture with/without additional treatment against placebo or sham or no treatment or same additional treatment. We excluded trials that compared different acupuncture methods or acupuncture against other treatments. Two review authors independently extracted data and assessed risk of bias. We used odds ratio (OR) and mean difference for binary and continuous outcomes respectively. We combined data in meta-analyses where appropriate. Thirty-three trials were included. They recruited 2293 participants with insomnia, aged 15 to 98 years, some with medical conditions contributing to insomnia (stroke, end-stage renal disease, perimenopause, pregnancy, psychiatric diseases). They evaluated needle acupuncture, electroacupuncture, acupressure or magnetic acupressure.Compared with no treatment (two studies, 280 participants) or sham/placebo (two studies, 112 participants), acupressure resulted in more people with improvement in sleep quality (compared to no treatment: OR 13.08, 95% confidence interval (CI) 1.79 to 95.59; compared to sham/placebo: OR 6.62, 95% CI 1.78 to 24.55). However, when assuming that dropouts had a worse outcome in sensitivity analysis the beneficial effect of acupuncture was inconclusive. Compared with other treatment alone, acupuncture as an adjunct to other treatment might marginally increase the proportion of people with improved sleep quality (13 studies, 883 participants, OR 3.08, 95% CI 1.93 to 4.90). On subgroup analysis, only needle acupuncture but not electroacupuncture showed benefits. All trials had high risk of bias and were heterogeneous in the definition of insomnia, participant characteristics, acupoints and treatment regimen. The effect sizes were generally small with wide confidence intervals. Publication bias was likely present. Adverse effects were rarely reported and they were minor. Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia. Larger high-quality clinical trials are required.link_to_subscribed_fulltex

Acupuncture in Modern Medicine

This book contains four integrated sections: 1) Acupuncture Research; 2) New Developments in Acupuncture; 3) Acupuncture Therapy for Clinical Conditions and 4) Assessment and Accessibility in Acupuncture Therapy. Section 1 provides updates on acupuncture research. From acupuncture effects in modulation of immune system to the role of nitric oxide in acupuncture mechanisms, chapters in this section offer readers the newest trends in acupuncture research. Section 2 summarizes new developments in acupuncture. The included chapters discuss new tools and methods in acupuncture such as laser acupuncture, sham needles, and new technologies. Section 3 discusses acupuncture therapy for clinical conditions. The chapters in this section provide comprehensive and critical views of acupuncture therapy and its application in common clinical practice. Section 4 takes a new look at the issues related to assessment and accessibility in acupuncture therapy. These issues are central to developing new standards for outcome assessment and policies that will increase the accessibility to acupuncture therapy

Chinese herbal medicine for chronic urticaria and psoriasis vulgaris: clinical evidence and patient experience

Urticaria and psoriasis are two of the most common chronic skin disorders that have a great impact on patients’ quality of life. Western medicine (WM) provides short-term symptomatic relief. However, a long-term strategy for managing refractory urticaria is lacking and unwanted side effects have been associated with long-term use of such therapies for psoriasis. In WM, chronic urticaria and psoriasis vulgaris are attributed to immune dysfunction (as the underlying internal factor) and are triggered by external factors. In Chinese medicine (CM), these two conditions share the same pathogenesis of an underlying deficiency of healthy, protective qi with an external pathogenic factor. In terms of treatment principle, the concept of using the same treatment for different diseases (异病同治) is very common in CM clinical practice. This is defined as applying the same treatment method to patients who suffer from different disease but have the same patterns. As both conditions result from immune dysfunction in WM, and share the same treatment principle from a CM perspective, the clinical management of these two conditions was evaluated to explore the current state of clinical evidence of Chinese herbal medicine (CHM). To provide the best available evidence on the efficacy and safety of CHM for both conditions, ‘whole evidence’ from both classical literature and clinical studies was evaluated systematically. Pre-clinical evidence was briefly summarised to explain potential mechanisms of CHM. In addition, practicability, such as patients’ experiences of using CHM, should be considered when CHM is considered as part of clinical practice. Objectives The objectives of this study are to: 1. evaluate the evidence of CHM for chronic urticaria and psoriasis vulgaris in the classical CM literature 2. evaluate the current clinical trial evidence of CHM for chronic urticaria 3. evaluate the current clinical trial evidence of compound glycyrrhizin (CG) (extract from Chinese herb gan cao甘草, radix glycyrrhizae) for psoriasis vulgaris 4. summarise the current experimental evidence of CHM for chronic urticaria and psoriasis vulgaris 5. explore patients’ experiences of using CHM for the treatment of chronic urticaria and psoriasis vulgaris. Methods Evidence Evaluation of CHM in Classical Literature Classical literature research was conducted based on the Zhong Hua Yi Dian. Citations related to chronic urticaria and psoriasis vulgaris were found by searching the Zhong Hua Yi Dian. Descriptive analysis was performed to calculate the frequency of formulae and herbs used in the Zhong Hua Yi Dian citations likely to involve chronic urticaria and psoriasis vulgaris. Evidence Evaluation of Chinese Herbal Medicine in Clinical Trials Clinical evidence was evaluated and synthesised through systematic reviews (SRs) of randomised controlled trials (RCTs). All SRs were conducted following the rigorous methodology of the Cochrane Collaboration. In addition, experimental evidence from modern literature was also summarised and incorporated into the SRs. Experiences of using Chinese Herbal Medicine A qualitative description method was used to explore patients’ experiences living with these two conditions and using CHM. Data were collected through individual semi-structured interviews. Results Evidence from Classical Literature The findings indicate that Xiao feng san消风散 is the most commonly reported formula for urticaria in the classical literature, and is still used in current clinical practice. For psoriasis vulgaris, the most frequently reported formula is Sou feng shun qi wan 搜风顺气丸, which differs from contemporary practice. The CHM treatments for these two conditions have several herbs in common, including fang feng 防风, jing jie 荆芥, gan cao 甘草, qiang huo 羌活, dang gui 当归and chuan xiong 川芎. Evidence from Clinical Trials Two SRs on CHM for chronic urticaria included 100 RCTs (10,258 participants). The results suggested that CHM alone (RR: 1.21 [1.15, 1.29], I2=0%) or as an add-on therapy to second-generation antihistamines (RR: 1.19 [1.10, 1.27], I2 = 54%) improved symptoms of chronic urticaria by 30% or more when compared with second-generation antihistamines. CHM was well tolerated by patients with chronic urticaria. Methodological flaws of the included studies and uncertain validity of outcomes limited the certainty of the findings. The key herbs used in the formulae for chronic urticaria in included studies appeared to have anti-inflammatory, anti-allergenic and antipruritic actions. The third SR focused on the add-on effect of CG to conventional therapy for psoriasis vulgaris. Eleven RCTs (1,200 participnats) were included in this SR. CG plus conventional therapy enhanced clinical response in terms of psoriasis area severity index (PASI) 60 (RR: 1.30 [1.21, 1.40], I2 = 6%) and90 (RR: 1.37 [1.21, 1.56], I2 = 0%), and did not increase the frequency of adverse events for patients with psoriasis vulgaris. However, the findings should be interpreted with caution due to methodological flaws in the included studies. The long-term add-on effect was uncertain. CG was considered to have an anti-inflammatory and immune-modulating effect based on experimental evidence. Experience of using Chinese Herbal Medicine The findings suggested that patients living with psoriasis vulgaris or chronic urticaria were burdened by physical and psychological effects. Long-term use of conventional treatments resulted in unpleasant side effects, which undermined participants’ confidence in conventional treatments. Based on participants’ own beliefs and experiences, they sought CHM as treatment. Most participants experienced satisfactory responses to CHM, but some found it hard to manage. Conclusions Evidence from classical literature showed the most frequently used formulae and herbs for both conditions in ancient times, which could guide contemporary clinical practice and drug discovery. SRs of clinical evidence produced through this research suggested that CHM was well tolerated and had promising benefits in improving clinical outcomes. These provided the evidence of efficacy and safety necessary for clinical decision-making, CM education and further research. A general summary of pharmacological action of key herbs indicated that the herbs possessed anti-inflammatory, anti-allergenic, antipruritic and immune-modulating actions. When choosing CHM, patients expected accessible treatments which could reduce relapse rates with no side effects. Understanding patients’ expectations and experiences is helpful when communicating with patients about their therapeutic options. Further, it provides direction for future research

Prescribing ‘Guiding and Pulling’: The institutionalisation of therapeutic exercise in Sui China (581 – 618 CE)

This dissertation investigates the development of therapeutic exercise known as daoyin 導引 (guiding and pulling) during the Sui dynasty (581–618 CE). The main research questions are 1) how and why did daoyin become an important component of state medicine during the Sui period, 2) why was it included systematically in Zhubing yuanhou lun 諸病源候論 (Treatise on the Origins and Symptoms of Medical Disorders), the earliest known nosological text compiled under the decree of the second Sui emperor Yangdi 隋煬帝and 3) in the context of the process of unification during the Sui, what is the larger significance of these initiatives for our understanding of the unique continuities in the history of imperial China? Central to this research is an investigation into the contemporary political, cultural and religious circumstances that influenced the decisions by the two Sui emperors to adopt therapeutic exercise, which was already widely popular among circles of literate elites and religious sects, into an official medical system. The vision of the second Sui emperor to promote therapeutic exercise as the main component of state medicine, in preference to all other medical treatments, led directly to the transformation of the state medical service with the employment of a disproportionally large number of daoyin specialists to the Sui court. This research argues that the inclusion of daoyin, together with advice on health regimes, under the newly-devised classification of disease in Zhubing yuanhou lun, is one of the most important medical innovations of the Sui. As a vignette that illustrates how the role of the state can extend its reach into social and community practice, this study also has wider implications for how, in contrast to the fragmentation of Europe after the fall of Rome, we understand the continuity of empire in China